Miami-Dade Schools

Audit: Healthcare firm may have overbilled Miami-Dade school district

A healthcare company that provided aid to disabled Miami-Dade students may have overbilled the school district by more than $1 million, according to the district’s chief auditor.

In a report presented Tuesday, chief auditor José Montes de Oca said an ongoing investigation into Maxim Healthcare Services has validated concerns that the company was inflating its bills. The company for years provided registered nursing, licensed practical nursing and respiratory therapy to hundreds of special-needs students who needed the care to continue their education.

Maxim denies that it overbilled Miami-Dade County Public Schools.

But Montes de Oca said a random sample pulled from thousands of invoices submitted between 2008 and mid-2011 revealed that Maxim:

• Charged for services to students whose attendance records show they were actually absent.

• Elevated the price of bills to the district by charging for a more expensive healthcare specialist than was needed.

• Charged for long periods of care for students who needed only intermittent services.

• Lacked documentation to back up its charges.

During the period in question, Montes de Oca said Maxim submitted 3,655 invoices worth nearly $11 million. He said his office randomly pulled 94, and found problems with one-third of them.

“When projecting these sampled results to the entire population of invoices, we determined that, based on the contract terms and industry standards, Maxim had overcharged the district $1,184,632,” he wrote.

Montes de Oca said the district’s investigation began in early September 2011 at the request of Superintendent Alberto Carvalho.

Carvalho and his staff had discovered problems with the company’s billings during a competitive bidding process for the same nursing services, district spokesman John Schuster said. The district then awarded the contract to a different company on an emergency basis, he said.

Just days after Carvalho requested an investigation, the U.S. Department of Justice announced that the Maryland-based company had agreed to pay $150 million to settle charges that it had engaged in a nationwide scheme to defraud Medicaid out of $61 million in home healthcare services. Submitting false bills “was common practice at Maxim from 2003 through 2009,” according to the Department of Justice.

Carvalho told School Board members earlier this month that he was “outraged” by the district’s findings.

“This is going to translate into a more aggressive investigation that could turn in a criminal direction,” he said.

He said the school district may seek restitution.

Montes de Oca said his staff met in March with Maxim representatives to discuss their preliminary findings and the audited invoices. He said the last correspondence from the company was an April 26 letter from a Lash & Goldberg attorney, who wrote that “Maxim denies that any sums are due for repayment to the [School] Board. As was the case throughout Maxim’s contractual relationship with the Board, Maxim was not overpaid for, and did not overcharge on, any of the referenced invoices.”

However, Montes de Oca said Maxim cut the district two checks last year worth $100,000 after the company was notified of the school district’s investigation. He said the company cited “overpayments and double payments by the district, and payments for a nurse provided by Maxim who had a suspended license.”

Rebecca Kirkham, a Maxim spokeswoman, said only that the company “has responded by denying the district’s allegations. We continue to review and investigate this matter internally.”

Montes de Oca said Tuesday that it is unusual for him to report preliminary audit findings before an investigation is concluded. He revealed little beyond his May 9 status update to board members, in which he said the company’s refusal to respond specifically to his office’s findings led him to reveal some results to the School Board.

He said he is working with the School Board attorney to conclude his probe.

In the meantime, the school district is aiming to improve its safeguards. Last week, the superintendent rejected new bids for nursing services while considering how to hold vendors more accountable.

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